=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982289120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALECIA RAGER LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2021
-----------------------------------------------------
Last Update Date | 03/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 COLONIAL BLVD STE 225
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-410-6221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17301 BROADWAY STREET #1004
-----------------------------------------------------
City | ALVA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-401-6221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALECIA RAGER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 239-410-6221
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------